Alcohol & Other Substance Use Disorders

Understanding Substance AbuseSubstance abuse refers to a set of related conditions associated with the consumption of mind- and behavior-altering substances that have negative behavioral and health outcomes. Social attitudes and political and legal responses to the consumption of alcohol and illicit drugs make substance abuse one of the most complex public health issues. In addition to the considerable health implications, substance abuse has been a flash-point in the criminal justice system and a major focal point in discussions about social values: people argue over whether substance abuse is a disease with genetic and biological foundations or a matter of personal choice.

In recent years, the impact of substance and alcohol abuse has been notable across several areas, including the following:

Adolescent abuse of prescription drugs has continued to rise over the past 5 years. The 2007 MTF survey found high rates of nonmedical use of the prescription pain relievers Vicodin and OxyContin. It is believed that 2 factors have led to the increase in abuse. First, the availability of prescription drugs is increasing from many sources, including the family medicine cabinet, the Internet, and doctors. Second, many adolescents believe that prescription drugs are safer to take than street drugs.

Military operations in Iraq and Afghanistan have placed a great strain on military personnel and their families. This strain can lead to family disintegration, mental health disorders, and even suicide. Data from the Substance Abuse and Mental Health Services Administration (SAMSHA) National Survey on Drug Use and Health indicate that from 2004 to 2006, 7.1 percent of veterans (an estimated 1.8 million people) had a substance use disorder in the past year.

In addition, as the Federal Government begins to implement health reform legislation, it will focus attention on providing services for individuals with mental illness and substance use disorders, including new opportunities for access to and coverage of treatment and prevention services.

DiagnosisThe newest revision of the diagnostic manual for mental disorders (the DSM-5) has updated the criteria commonly used to diagnose either an alcohol disorder (commonly referred to as alcoholism) or a substance use disorder.

According to the DSM-5, a “substance use disorder describes a problematic pattern of using alcohol or another substance that results in impairment in daily life or noticeable distress.” As with most addiction problems, despite any consequences a person who has a problem with either alcoholism or drugs suffers, they will generally continue to use their drug of choice. They may make half-hearted attempts to stop or cut back their use, usually to no avail.

The DSM-5 states that in order for a person to be diagnosed with a disorder due to a substance, they must display 2 of the following 11 symptoms within 12-months:

Consuming more alcohol or other substance than originally planned

Worrying about stopping or consistently failed efforts to control one’s use

Spending a large amount of time using drugs/alcohol, or doing whatever is needed to obtain them

Use of the substance results in failure to “fulfill major role obligations” such as at home, work, or school.

“Craving” the substance (alcohol or drug)

Continuing the use of a substance despite health problems caused or worsened by it. This can be in the domain of mental health (psychological problems may include depressed mood, sleep disturbance, anxiety, or “blackouts”) or physical health.

Continuing the use of a substance despite its having negative effects in relationships with others (for example, using even though it leads to fights or despite people’s objecting to it).

Repeated use of the substance in a dangerous situation (for example, when having to operate heavy machinery, when driving a car)

Giving up or reducing activities in a person’s life because of the drug/alcohol use

Building up a tolerance to the alcohol or drug. Tolerance is defined by the DSM-5 as “either needing to use noticeably larger amounts over time to get the desired effect or noticing less of an effect over time after repeated use of the same amount.”

Treatment for Substance Use DisordersThe treatment system for substance use disorders is comprised of multiple service components, including the following:

Individual and/or group counseling

Inpatient and residential treatment

Intensive outpatient treatment

Partial hospital programs

Case or care management

Medication

Recovery support services

12-Step fellowship

Peer supports

A person accessing treatment may not need to access every one of these components, but each plays an important role. These systems are embedded in a broader community and the support provided by various parts of that community also play an important role in supporting the recovery of people with substance use disorders.